xviii, 478 pages : 24 cm

This book provides the reader with a systematic and comprehensive approach to substance abuse treatment. It explores new integrations of familiar approaches, introduces innovative theoretical constructs, and describes new practical applications. The models and methods presented have been developed specifically to address treatment planning for patients who have been recurrent treatment failures in both psychotherapy and addiction treatment programs. These approaches are also applicable to less refractory cases of substance abuse, and to nonsubstance addictions, such as compulsive sexual behavior. Dr. Richards describes the process of addiction as a movement through a cycle of three primitive states of self-experience. These are: (1) a position typified by egotism, assertiveness, and super-confidence (the Inflated/Grandiose position); (2) a position typified by depression and helplessness (the Depleted/Depressed position); and (3) a position typified by isolation, fantasy, and self-absorption (the Detached/Schizoid position). Movement through this cycle is driven by failures in self-regulation, and by the time-limited, self-undermining, and only partially effective substitute solution to these failures that drugs provide. In addition, the substance abusing patient's reliance on paranoid processes (splitting, projection, and introjection) are shown to be the cornerstone to continued drug dependence as a substitute for poor self-regulation. In addition to advancing theory, this volume describes in detail a comprehensive system for assessment and treatment planning based on the dual diagnosis paradigm. The system consists of three interrelated concept sets and an understanding of their relationships: drug categories, symptom complexes, and biopsychosocial functions of addiction. Following this formulation a description of recovery processes for addiction/mental illness and corresponding treatment needs provides the basis for intervention. Using abundant clinical examples, Dr. Richards presents and applies the fundamental principles of substance abuse treatment

Includes bibliographical references (pages 437-456) and index

Strategies -- Parallels and paradigms -- Confronting a problem -- Defining syndromes -- Emergent syndrome -- Defining dual diagnosis populations -- Key dimensions of dual diagnosis work -- Levels of severity for two pathological processes -- Developmental view -- Why the chicken-or-egg-first question in absurd -- Biases in reasoning -- Syndrome definitions and subpopulations -- Defining categories of dual diagnosis work -- Clues to treatment strategies -- Mapping a paradigm -- Disturbances in four spheres of functioning -- Incidence of depression in alcoholism -- Sorting casual links -- Role of depressed affect in the etiology of alcoholism -- Failures in self-protective biases -- Clinical implications -- Daily experiences and memory for moods -- Dual diagnosis perspective -- Simplifying the dual diagnosis dilemma -- Need for a general heuristic system -- Five symptom complexes -- Five biopsychosocial functions of addiction -- Drug of choice -- Drug effects and drug classes -- Formulating dual diagnosis problems -- Treatment -- Reciprocal assessment -- Assessment strategies

(cont) Global and comprehensive instruments -- Focused assessment instruments and procedures -- Relapse, drug switches and complicated bereavement -- Reciprocal treatment strategies -- Alternative metaphors for treatment -- Identifying recovery processes and patterns -- Why AA works -- Phases of recovery, stages of treatment -- Clinical formulation and process theory -- Process theory intervention -- Emergence of new material in psychotherapy -- Creativity in therapy -- Special topics -- Basic personality disorders -- Personality and psychopathology -- Personality and addiction -- Basic personality disorders in dual diagnosis work -- Dependent styles -- Independent styles -- Ambivalent styles -- Dysfunctional detached styles -- Personality decompensation and the spectrum disorders -- Process and spectrum disorders -- Schizotypal-schizophrenic spectrum -- Cycloid-affective spectrum -- Paranoid-narcissistic spectrum -- Psychopathy, criminality and substance abuse -- Psychopathy and dual diagnosis work -- Relationship between drug use and criminality -- Psychopathy in the context of the personality disorders

(cont) Assessment of severity of psychopathy -- Symptom complexes and functions of addiction -- Drugs of choice and routes of administration -- Response to treatment -- Risk assessment of substance-involved offenders -- Program models for correctional and forensic populations -- Program design and administration -- Bridging traditions -- Service delivery in a bifurcated system -- Coordinated or linkage model programs -- Hybrid or integrated programs -- Program design in the integrated model -- Issues in program administration -- TAT protocol illustrating failures in self-regulation -- Arousal-induced shifts in modal psychological functioning-depressed substance abusers -- Summary of an EMP -- Addiction severity index

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